Scrutiny of long-term use of narcotic analgesics for nonmalignant pain has sharpened because of increased frequency of use, higher awareness of adverse events, and more reports of deaths from unintentional overdose. According to the CDC, unintentional drug overdose is the second-leading cause of accidental death in the U.S., with about 40% of such deaths caused by prescription opioids.1 A focus on perceived undertreatment of pain, coupled with aggressive marketing of opioids such as extended-release oxycodone (OxyContin), might have produced unintended negative consequences, particularly the long-term and potentially harmful use of opioids for nonspecific musculoskeletal pain. In several new studies, researchers addressed these issues. In a study from two large western U.S. health plans with about 4 million enrollees, the prevalence of long-term opioid use for noncancer pain increased strikingly from 1997 to 2005 in all age …